BJPsych International · Jan 29, 2026

Improving detection and treatment of psychological distress during menopause: evidence from a clinical hormone replacement therapy cohort

By Hendriks O, Kamal A, Saini P et al.

BACKGROUND: Menopausal transition is a period of psychological vulnerability, yet suicidality remains underassessed. Hormone replacement therapy (HRT) may influence mood symptoms, but its mental health effects - particularly regarding suicidality - are poorly understood. AIMS: To evaluate changes in depressive symptoms, menopause-related distress and suicidality among menopausal women attending a specialist clinic, and explore whether outcomes differed across HRT regimens and baseline risk factors. METHOD: We analysed routinely collected data from 957 women attending a UK menopause clinic. All participants received some form of treatment following their initial consultation. Participants completed the Patient Health Questionnaire-9 (PHQ-9) and Menopause Depression Rating Scale (MENO-D) at baseline and follow-up (2-6 months later). Mixed-design analyses of variance assessed changes over time, including interaction effects for HRT type and baseline risk factors (body mass index (BMI), smoking, suicidality, antidepressant use). RESULTS: Depressive symptoms and menopause-related psychological distress significantly declined over time (around 46% reduction on average). The largest improvements were observed among women receiving oestrogen-progesterone-testosterone combinations, although similar gains were also seen in oestrogen-progesterone and oestrogen-testosterone groups. Suicidality (PHQ-9 item 9) decreased by 92% among those with baseline ideation, but this was not moderated by HRT type. Self-worth (MENO-D item 4) also improved, but similarly showed no significant moderation by HRT regimen. Higher BMI was associated with worse baseline mental health, but did not moderate treatment outcomes. CONCLUSIONS: Combined HRT, including formulations with testosterone, was associated with substantial improvements in mental health outcomes. Suicidality was a distinct symptom profile, often underdetected by general depression scores. However, findings are exploratory and should be interpreted cautiously because of the lack of a control group, observational design and small sample sizes in some subgroups. These results highlight the need for menopause-sensitive mental health assessments and integration of psychological screening into routine menopausal care.

doi.org/10.1192/bji.2025.10094 Open access PubMed 42984986 Interventions